Provider Demographics
NPI:1295228104
Name:JAFFE, SUSAN ANDREA (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANDREA
Last Name:JAFFE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14857 W DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5948
Mailing Address - Country:US
Mailing Address - Phone:623-810-1630
Mailing Address - Fax:
Practice Address - Street 1:14857 W DAHLIA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5948
Practice Address - Country:US
Practice Address - Phone:623-810-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist